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Comment by jnbiche | Hacker News Reader

> Pseudoaddiction exists. But actual addiction also exists, and it's more dangerous and more likely to happen.

Many people kill themselves over chronic untreated or undertreated pain. I've seen studies showing that people with chronic pain kill themselves at twice the rate of those without chronic pain (even that seems low to me) [0] and various other similar studies. Assuming this is true, and that the two are causally related, then opiate deaths and suicide deaths due to chronic pain are in the same order of magnitude.

If you any of you are unfortunate to end up with a condition that causes significant chronic nerve pain, you'll quickly understand how this can be.

0. https://annals.org/aim/fullarticle/2702061/chronic-pain-amon...

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As someone married to someone with chronic pain... Opioid pain killers tend to be ineffective anyways - they will provide a window of pain killing that is longer than other substances (when taken within safe limits) on the order of months but their efficacy is not unlimited and even being willing to heavily addict yourself to Oxy is likely going to cease helping your pain after half a year. This is part of the cause of this epidemic, people were _entirely falsely_ prescribed an ineffective medication that has heavy side effects.

My spouse managed to get a medical supply of mj and that has helped her get back into life, given her pain source is from arthritis and a few other issues it'll probably never be a thing she'll be without but the few studies out there on mj have a positive view of long term pain treatment on it.

Chronic pain is a very serious condition that can ruin lives, it is extremely disgusting to see what has happened with Oxy and heavier penalties are needed.

> This is part of the cause of this epidemic, people were _entirely falsely_ prescribed an ineffective medication that has heavy side effects.

It really depends. Opiates work for some people, with some conditions. People should have the choice, just like with MJ. For me, one opiate worked, and another didn't (and made things worse. it was Oxycontin, incidentally, haven't taken it in many years).

Also, people with chronic pain take opiate breaks for the reasons of tolerance you describe.

And yes, I've heard MJ works for many people (I've never tried it for my conditions, since it's still not legal where I live. Also, I tried it a couple of times in college and hated how it made me feel, no way I could work on MJ). But I'm very happy it works for your spouse and that she's able to obtain it. Chronic pain is brutal. If MJ is ever legalized where I live I might try it just to see if it works.

There are many varieties of cannabis. Having a bad experience with one is not a reason to eschew in favor of opiates. you didn't eschew opiates because you had one bad variety.

No way I could work without.

If mj is legalized I'd suggest you give it another go, the strains you'd smoke to get high cause my wife's pain to heighten while as more cbd heavy strains help reduce it from her life - it's not critical to avoid thc entirely (and it may help the cbd act - research isn't in here but pure cbd oil products are less effective than a mix for a lot of people).

And yea, Canada is nice like that.

> It really depends.

In the past, throwing opioids at chronic pain patients and calling it a day was par for the course.

Now, there's a level of awareness that not only are opioids not very good for managing chronic pain all of the time, they can even make pain sensitivity worse in the long-run.

Criminalizing pain patients is disgusting, but I'm hoping we can reach an equilibrium where those who have chronic pain are able to seek adequate treatment and opioids aren't the first line of treatment or overprescribed.

As someone with family members suffering from chronic pain, I know several people who have switched to MMJ or CBD supplements with great success. One of them took pain killers for decades and hasn't needed them in years because of CBD.

CBD won't affect you cognitively, if you have the time, money and your doctor thinks it's a good idea, it wouldn't hurt to give it a go.

To add to your argument, “addiction” is not a cause of death, it is a risk factor for various unnatural causes such as suicide and overdose. The same could be said for chronic pain, but it is pretty easy to understand why chronic, untreated pain would lead to suicide. The connection between addiction and suicide is much more complex, and may have more to do with the reality of being an addict in modern society than the medical consequences of the addiction itself.

I don't want to detract from your point about sympathy for chronic pain. But you can't mainline oxycodone into everyone who claims to have chronic pain, because that system is easily abused, as we've seen. A more nuanced approach is needed. We need a balance, and IMO we need to improve our ability to objectively measure pain instead of relying on a 1-10 scale.

I am curious about your conclusion that "opiate deaths and suicide deaths due to chronic pain are in the same order of magnitude", though. According to my simple Googling, opioids are the cause of death for 21.7 per 100,000 people in the US, while suicide is only 14 per 100,000. So per your link, chronic pain suicide is about 10% of that, or 1.4 per 100,000. That means opioid deaths are about 10-15x more common, or am I missing something?

edit: I'm realizing my understanding of this debate is significantly out-of-date. So I apologize if anything I've written seems tone-deaf, that wasn't my intention.

But you can't mainline oxycodone into everyone who claims to have chronic pain

You say this like it should be taken for granted, but honestly, with the amount of deaths we have from people overdosing on illegal fentanyl, it might be better at this point if we simply gave less-overdose-prone opioids to anyone who was addicted!

> Many people kill themselves over chronic untreated or undertreated pain.

The answer is to give people access to better treatment for pain.

That isn't giving them opioids.

They end up addicted to opioids, with a bunch of side-effects caused by opioids, and they're still in pain. Their functioning is decreased.

https://www.england.nhs.uk/south/2019/06/25/seans-story/

https://www.bbc.co.uk/programmes/b04wv052

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